DESCRIPTION: This proposal is a collaboration between New York University and law enforcement organizations including the Fraternal Order of Police, the Metal Trades Department, and community organizations including the Latin American Workers Project and the Beyond Ground Zero network. The Division of Pulmonary and Critical Care Medicine, the Bellevue/NYU Occupational and Environmental Medicine Program, and the NYU/Bellevue Department of Psychiatry have all participated in health evaluations of responders and local residents after the destruction of the World Trade Center (WTC). The populations evaluated in these programs included workers involved in rescue and recovery activities, including firefighters in the Fire Department of New York (FDNY), day laborers involved in clean-up activities, and local residents. These initial studies have revealed significant respiratory and mental health complaints and identified respiratory findings in the exposed population. We now propose to extend our efforts of evaluating health effects of the destruction of the WTC by providing long-term medical and mental health evaluations of three target groups involved in the rescue and recovery efforts of lower Manhattan. Working with the Fraternal Order of Police, we will recruit law enforcement officers including members of the New York Police Department and transit officers for long-term screening. Working with community organizations including the Latin American Workers Project and the Beyond Ground Zero network, we will monitor the medical and mental health of day laborers, who were responsible for the removal of the WTC debris from downtown buildings, and therefore the economic recovery of New York City. Our third target group will include members of the Metal Trades Department, a coalition of seventeen unions. We now propose long-term screening for potential active or latent adverse health effects resulting from rescue or recovery activities with exposures to WTC dusts. This screening will be performed with the following aims: Specific Aim 1. To perform longitudinal health evaluations in a population of WTC responders, (members of the Fraternal Order of Police and New York City Police Department, New York City day laborers, and Metal Trades Council) to screen for medical complications associated with the WTC disaster with a focus on sinus disease, upper and lower respiratory diseases, and gastroesophageal diseases. Specific Aim 2. To perform long-term mental health screening of a population of WTC responders for persistent post traumatic stress disorders and depression. Specific Aim 3. To develop a referral program for responders with medical or mental health complaints to medical and mental health specialists with experience with WTC-associated health issues. Specific Aim 4. To develop responsive outreach and educational programs for responders and their families and for local physicians to improve understanding of medical and mental health issues associated with the WTC disaster.